The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 has listed attenuated psychosis syndrome (APS) as a “condition for future study.” APS can involve mild delusions, hallucinations, and disorganised speech, with relatively intact reality testing in the absence of an apparent psychotic disorder, and has been thought to be a risk state for later schizophrenia spectrum disorders. To examine the clinical utility of this diagnosis, researchers performed a systematic review of 56 articles and meta-analysis of 23 prospective studies that used different APS definitions.
The prevalence of APS was 0.3% in the general population and 3.5% in college students. The most common attenuated psychotic symptoms included derealisation, overvalued beliefs, and simple auditory hallucinations, such as hearing one’s name called. The risk for progression to a clear psychotic disorder (usually schizophrenia) was 23% at 36 months.
While many schizophrenia patients retrospectively report prodromal symptoms of APS, at least 30% do not experience these. Similarly, most people with apparent APS do not rapidly become psychotic. For a large number of patients, however, odd experiences and ideas and an altered sense of reality do predict later obvious illness, and early treatment could prevent such progression.
Many people with APS do not seek help because they do not think they are sick. The challenge to clinicians is to identify high-risk patients — especially in families of psychotic patients — and engage them in a therapeutic relationship that at least facilitates regular monitoring.